Fractures Clinical Trial
Official title:
CT Analysis of Structural Buttresses in the Traumatised Nose - A Basis for Decision Making for Early Open Rhinoplasty and Biomechanical Study of Nasal Structural Support
Hypothesis: There are 5 support buttresses in the complex osteocartilaginous architecture of
the nose.
1. The membranous septum;
2. The Right nasal bone;
3. The Left nasal bone;
4. The perpendicular plate of the ethmoid;
5. The vomer, vomerine groove and anterior nasal spine.
Aim:
1. Study the 3-dimensional anatomy of the nasal buttresses.
2. Diagnose fracture patterns in the nasal buttresses.
3. Identify the buttress fractures associated with deviation of the external nasal
morphology.
4. Identify the buttress fractures associated with septal deviation.
5. Assess the airflow patterns and its associated distribution of flow velocity, pressure,
and wall shear stress in the nasal cavity for patient specific models with nose
fracture.
6. Assess the stress distribution in the nasal bone structures subject to various
scenarios of loading conditions.
Methodology:
67 consecutive patients admitted for facial fractures and who undergo routine CT scans of
the face with our protocol of axial and coronal sections taken at 0.6mm and gantry 0 are to
be studied. The CT scans are evaluated to assess the position, comminution and displacement
of the 5 said buttresses.
The buttresses are graded Grade 1 Simple fracture without displacement Grade 2 Simple
fracture with displacement Grade 3 Comminuted fracture without displacement Grade 4
Comminuted fracture with minimal displacement Grade 5 Comminuted fractured with displacement
The septum is graded from Grade 0 Septum is straight Grade 1 Septum is deviated by less than
1 half the distance from the midline to the nasal turbinate Grade 2 Septum is deviated by
more than 1 half the distance from the midline to the nasal turbinate Grade 3 Septum is
almost touching the nasal turbinate
Variables to be assessed included
1. Grade of Severity of Nasal and Septal fracture
1. Which is the weakest buttress that is most commonly broken?
2. Which is the least often fractured and strongest buttress?
3. Which buttress or buttresses are involved in a undisplaced septal fracture?
4. Which buttress or buttresses are involved in a displaced septal fracture?
5. Which buttresses or buttresses are involved in a undisplaced nasal fracture?
6. Which buttress or buttresses are involved in a displaced nasal fracture?
7. For a buttress to be displaced, the number of fractures in a single buttress?
2. Assessment of biomechanical stability
1. Assessment of stress distribution in the nasal buttresses for various scenarios of
external loadings
2. Assessment of nasal fracture patterns in different traumatic forces
3. Assessment of stress wave propagation in the nasal bones during impact.
3. Assessment of nasal air-flow via the nasal airways
Methods for data management and analysis (incl. Biostatistical check)
1. Segmentation and Reconstruction of 3D Nasal Model
Given the CT images of a patient, the nasal bones and surrounding facial bones are
segmented and a 3D model of the bones is reconstructed. This can be accomplished using
a segmentation and 3D reconstruction software. We have developed a preliminary version
of the software for segmenting and reconstructing 3D model of craniofacial bones based
on fast marching method. The software can be adapted to focus on reconstructing 3D
model of the nasal buttresses.
2. Nonlinear Registration with Reference Model
The 3D fractured model is registered with a normal reference model for fracture
analysis. A novel nonlinear registration technique is required to decouple normal
variations among normal people and variations due to fractures. In this way, the normal
reference model can be deformed in a manner consistent with normal variations to
register to the fractured model. After registration, the registered reference could
serve as a model of the patient prior to the injury. Moreover, differences between the
fractured model and the registered reference would indicate variations due to
fractures. The extent of the fractures and displacements of bones can also be measured.
To accomplish the novel nonlinear registration, a generalized form of source separation
method is needed. In particular, the idea of discriminates subspace analysis (Zhang and
Sim) developed by our colleagues for analyzing variations of facial images for face
recognition may be applicable. The method can decouple variations due to different
people and variations due to illumination and view point.
To enhance the accuracy of analysis, multiple normal reference models may be required
for the patients in different ethnic groups.
3. Visualization of 3D Models
Generic visualization tools do not discriminate between the nasal bones and other
craniofacial bones. It is difficult and inconvenient to use them to visualize only the
nasal structure. So, a software tool will be developed to visualize the nasal structure
of the fractured models. It can also be used to visualize the registration of the
fractured models with the normal reference and other fracture analysis results.
4. Classification of Fracture Patterns
After detecting and measuring the fractured bones, the fractured models can be classified
according to their fracture patterns. This can be accomplished manually with the assistance
of classification software.
Subsequently,
1. Refinement of Nonlinear Registration Method
Refinement of the nonlinear registration method will be performed to improve its
accuracy.
2. Biomechanical studies
Three dimensional finite element models of the nose, in particular the septum will be
constructed from the CT scans. Finite element analysis will be carried out to assess the
deformation, stress wave propagation and stress distribution in the nasal structures. Flow
simulation using computational fluid dynamics will also be carried out to assess the flow
pattern in the nasal cavity due to the nasal fracture.
Finally,
1. Biomechanical studies
Three dimensional finite element models of the nose with various proposed techniques for the
correction of nasal fracture will be carried out to assess the strength and weakness of the
resulting nasal structures due to the corrective surgical procedure. Computation fluid
dynamics will also be carried out to assess the flow pattern or nasal patency of the airway
after the proposed surgical corrections.
;
Observational Model: Case-Only, Time Perspective: Prospective
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